The following forms can be downloaded and printed. Please fill out the forms and bring in all required documents to the clinic to establish a new chart. If you have any questions, please call 505-908-2307.

 

Do Not Email forms back to clinic, they will not be accepted.

New Patient Forms
basket_modified.png

CBNHC New Patient Registration Packet 2021

Click Here For Forms

basket_modified.png

NoticePrivacyPracticePamphlet-2014

Click Here For Pamphlet

Health Board Forms

Canoncito Band of Navajos Health Center, Inc. is currently accepting Letters of Interest with a Resume/Application for one (1) position on its Five (5) member Board of Directors. The position will fill a 3-year term beginning July 2021 to March 2024.

Applications accepted from May 24, 2021 to June 11, 2021 @ 3:00pm MSDST

basket_modified.png

 Community Announcement: Clinic Will Be Closed On Thursday June 10th For Maintenance